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E�`kPPCATfON FOR PLUMBING PERMIT
< CITY OF CUPERTINO
rvViszo EP25 1967 1 sanitary No.
o a Date 196 > Permit No �S—/,
3� CITY OF CIJPERTHf !D Fee$
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
`o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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4 Use of Premises
�9 FFA«s
00 �p /
" y_CCLR/�M N a/ Address 7-a�
O 3 Ownera
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/T10�S �Lc `�CaCe `�1 �i�/y�ct
z By If "9/47 Address c yl
O CONTRACTOR, AGENT
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, 11a o State License 7C) S 7Y8 ApprovedUNILL"' .fl D-
IeF U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size T1-
1--Water Closet Material CO.
Bath Tub To Curb
Shower To Prop. Line
Lavatories 3 To Existing
Kitchen Sink Not Co".
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tmy To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAl. FEES
Urinal Fixture Fee 9 / 0 6-0
Area Drain Main Drain Fee n'O
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee / -57
Relief Valve Gas Fee 5-0
Vac Breaker
Skimmer
Filter
Permit Fee aZ W
Total Total Fee 'p, 0 • 6-0